Since then, we've helped a lot of septic rodents
According to the CDC, over a million adults in the United States develop sepsis each year
Two years ago, scientists said that vitamin B3 might treat sepsis, and the scientists did not put too fine a point on it:
...In conclusion, we strongly suggest that vitamin B3 be investigated as a therapy for sepsis, including that caused by COVID-19, ideally as a single agent at high dose...
The scientists had just spent six pages and over a hundred footnotes explaining that "If the primary pathology is competition for depleted NAD+stores, the most rational intervention would be to increase NAD+supply," which is what vitamin B3 does.
They understood that this was not the usual way of thinking about sepsis. "We advocate adjusting our understanding of pathogenesis of infectious illness away from a microbe-oriented view, such that the microbe is seen as ‘causing’ the disease, towards a host NAD–metabolism-oriented view, where the microbe is seen as triggering an evolutionarily conserved response that shifts NAD metabolism."
It wasn't a new idea. Three years earlier, a 2018 study found that the administration of the nicotinamide riboside form of vitamin B3 prevented oxidative stress and organ injury in sepsis. But although not a new idea, it was an idea whose time had come, and scientists went to work.
So far this year, three published studies all agree that treating sepsis with vitamin B3 works. One study found that vitamin B3 protected the brain in septic mice. Another study found that vitamin B3 protected the ovaries in septic rats.
A third study found that vitamin B3 treated not only the symptoms of sepsis, but sepsis itself, improving the survival of septic mice, by preventing the exhaustion of their immune system.
The CDC Takes On Sepsis
Today's New York Times announces that the United States Centers for Disease Control is taking on sepsis.
The Centers for Disease Control and Prevention on Thursday released new guidelines to help hospitals quickly detect and treat cases of sepsis. The road map, a 35-page document outlining the “core elements” of a hospital sepsis program, is meant to help administrators bring together experts from various medical disciplines to detect and treat sepsis faster.
Why the attention to sepsis? According to the New York Times, the CDC predicts that about 1.7 million people will become septic this year, and 350,000 of them will die of it or get moved to hospice. Sounds like an emergency.
That's why I was surprised to find listed at clinicaltrials.gov just one, single clinical trial for vitamin B3 and sepsis, a Phase 3 study in France looking at whether high-dose vitamin B3 can prevent kidney injury during septic shock. This kidney study has been going on for years, and won't finish this year.
It takes a long time and a lot of money for these animal studies to turn into pharmaceutical-grade human clinical trials -- 3-9 years, maybe. By then about one to three million more adults in the United States will have died of sepsis, even though a safe, affordable, easily available vitamin might be able to bolster their immune systems and allow many to recover.
It has been more than two years since those scientists said they "strongly suggest that vitamin B3 be investigated as a therapy for sepsis." And it has been investigated, and with positive results.
Vitamin B3 was first discovered about 100 years ago because it cured pellagra, a disease plaguing millions of adults in the US, and killing 100,000. Pellagra was originally thought to be infectious, but turned out to be a nutritional deficiency that could be cured by a very small dose of niacin. So it's not crazy to suppose that sepsis, which is even more deadly and is not linked to any particular type of bacteria, could similarly be treated by a larger dose of vitamin B3, enough to restore immune function.
Are we going to watch millions of adults die of sepsis without even mentioning to them that there is a safe, affordable, easily available vitamin that is not going to do any harm and might even offer a cure?
I think we will.
Part of the problem is just plain information overload. Neither the New York Times nor the CDC mentions the vitamin B3 research, almost certainly because they don't know about it. Your primary care physician certainly does not know about it.
The research is obvious enough if you press your nose up against it, but not from a distance. Nobody knows how many thousands of academic journals are publishing how many millions of articles on every conceivable topic, and it's impossible for more than just a handful of experts to be really up to speed on any particular narrow question, like whether vitamin B3 shows substantial promise with sepsis.
And that handful of experts is only responsible for advancing the science. They aren't responsible for setting public policy. In fact, those specialized experts mostly don not have access to great communication channels beyond merely casting an urgent plea -- a "strong suggestion" -- into the blizzard of scientific journals articles.
Indeed, those scientists that lift their head from their papers and join the public discourse on social media are likely to be abused and shouted down for their efforts. A modern Paul Revere could ride through the streets of Twitter calling, "Sepsis is coming! Try vitamin B3!" and get labeled a "total whack job" by the social media mob.
The other part of the problem is that America's legal system treats every potential cure as a potentially dangerous pharmaceutical, even if the potential cure is not dangerous at all. Under American law, you cannot even sell a glass of water to a thirsty person if your stated intention is to cure a specific disease or condition. You can say that the water will help their body function better. And the same goes for vitamin B3.
Ironically, that's exactly what the scientists wrote in the FEBS Journal more than two years ago, that we should stop thinking of sepsis as a microbial disease to be cured, and start thinking of it as a dysregulation of the body's NAD metabolism that needs to be adjusted.
And if sepsis is not a disease, but a dysregulation of the body's immune system that can be adjusted with a safe, affordable, easily available vitamin, then we don't need Phase 4 human clinical trials before we start saving lives; we just need to try it out and see if it works, and measure the results as we go.
Is there a way that can happen?
I'll probably get called a whack job just for suggesting it.